DOCSLIB.ORG

Hemodynamic Consequences of PEEP in Seated Neurological Patients-Implications for Paradoxical Air Embolism

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hemodynamic Consequences of PEEP in Seated Neurological Patients-Implications for Paradoxical Air Embolism ANESTH ANALG 429 1984;63:429-32 Hemodynamic Consequences of PEEP in Seated Neurological Patients-Implications for Paradoxical Air Embolism Nancy A. K. Perkins, MD, and Robert F. Bedford, MD PERKINS NAK, BEDFORD RF. Hemodynamic 47% and right atrial pressure (RAP) increased from 3.6 +- consequences of PEEP in seated neurological patients- 0.7 SEM mm fig to 8.9 ? 0.9 SEM mm Hg (P < 0.05). implications for paradoxical air embolism. Anesth Analg Pulmona ry capillary wedge pressure (PCWP) did not in- 1984;63:429-32. crease significantly during PEEP. RAP exceeded PCWP in only two patients before PEEP, but RAP exceeded PCWP In order to better understand the hemodynamic conse- in seven patients during PEEP. Weconclude that PEEP is quences of the use of positive end-expiratory pressure (PEEP) potentially detrimental during operations in the seated po- in patients in the seated position, 22 patients undergoing sition because it not only impairs hemodynamic perform- neurosurgical operations were monitored with radial arterial ance, but might predispose patients with a probe-patent and thermistor-tipped Swan-Ganz catheters both before and foramen ovule to the risk of paradoxical air embolism. during 10-cm H20 PEEP. Significant (P < 0.05) reduc- tions in cardiac output (15%), stroke volume (15%), and Key Words: ANESTHESIA-neurosurgical. VENTI- mean arterial pressure (24%)occurred with the introduction LATION-positive end-expiratory pressure. HEART- of PEEP, while pulmonary vascular resistance increased myocardial function. EMBOLISM, AIR-paradoxical. Positive end-expiratory pressure (PEEP) has been ad- (9-ll), human volunteers (12), and patients with car- vocated for neurosurgical patients undergoing oper- diorespiratory disease (13-15), these studies have fo- ations in the seated position, both as a preventive cused primarily on changes in cardiac output and ven- measure to avoid air embolism (1,2) and as acute treat- tricular performance without regard to changes in ment when air embolism is suspected (3,4). In these interatrial pressure gradient. situations, it has been proposed that an increase in This study was undertaken to examine the hemo- venous pressure induced by PEEP might help to pre- dynamic impact of PEEP in anesthetized patients in vent entrainment of air into the circulation or to stop the seated position: a situation in which decreased air entrainment after air embolism has been detected. lung blood volume due to the effect of gravity (16) The use of PEEP in this setting, however, is contro- might have unanticipated effects on the cardiovas- versial, because it has been suggested that such an cular response to PEEP and in which changes in in- increase in venous pressure might promote paradox- teratrial pressure gradient due to posture may pre- ical (systemic) air embolism if the patient were one of dispose patients to paradoxical air embolism (17). the 25-35% of the population with an asymptomatic foramen ovale (5,6), thus tending to drive air bubbles from the right atrium into the left atrium and by- Methods passing the filtering function of the lungs (7,8). Al- The subjects of the study (N = 11) were informed, though the hemodynamic effects of PEEP recently consenting adult patients (ASA class I or 11) scheduled have been examined extensively in supine animals for elective cervical laminectomy at the C5-6 level. The protocol was reviewed and approved by the Hu- This study was supported in part by United States Public Health man Investigation Committee Of the University Of Vir- Services Grant T32-GM-075900-04. ginia. Anesthesia was induced with thiopental (4 Received from the Department of Anesthesiology, University mg/kg), and maintained with 70% N@ in o2and of Virginia Medical Center, Charlottesville, Virginia. Presented in part at the American Society of Anesthesiologists Annual Meeting, morphine (0.3-0.5 mg/kg Pan- Las Vegas, Nevada, October 1982. Accepted for publication De- curonium (0.1 mg/kg-- intravenously) was given to fa- cember-30, 1983. cilitate endotracheal intubation, and ventilation was Address correspondence to Dr. Bedford, Department of Anes- thesiology, University of Virginia Medical Center, Charlottesville, to maintain PaC02 between 30 and 35 mm VA 22908. Hg. Using pressure waveform control, radial and 0 1984 by the International Anesthesia Research Society ANESTH ANALG PERKINS AND BEDFORD 430 1984;63:429-32 thermistor-tipped quadruple-lumen pulmonary ar- 4PCWPl- 30 - tery catheters were placed percutaneously, and car- I diovascular pressures were transduced with Bentley PAP (mmHg) Model 800 transducers and were referenced to the I level of the 6th intercostal space anteriorly. End-tidal 0- CO, fraction (Beckman LB-2) and all cardiovascular 5- pressures were continuously recorded using a Brush I Model 440 strip-chart recorder. Placement of the pul- monary artery catheter tip in a perfused (zone 111) lung segment (16) was documented by observing a de- crease in end-tidal COz fraction during each pulmo- nary capillary wedge pressure (PCWP) determination " (Fig. 1) (18). If a measurable decrease in end-tidal CO, I+ 1- MIN~ did not occur during balloon inflation, the position of the pulmonary artery catheter was manipulated using Figure 1. Representative strip-chart record demonstrating a de- a sterile introducer sleeve until proper placement of crease in end-tidal CO, fraction (FEKO~) during PCWP determi- nation. Because the decrease in FEKo~ indicates a decrease in re- the catheter tip was verified (mean change in F,<o, gional pulmonary blood flow, the PA catheter tip must be located =4.2-+0.1%SEMtO3.9+-0.1%SEM,P<0.001).All in a perfused lung segment where PCWP would reflect left atrial patients received 1 L of 5% dextrose in lactated Ring- pressure. er's solution intravenously and then were placed in the semirecumbent seated position. Heart rate (HR), mean arterial pressure (MAP), right atrial pressure Discussion (RAP), pulmonary arterial pressure (PAP), pulmo- Patients undergoing operations in the seated position nary capillary wedge pressure (PCWP), and cardiac are at a considerable hernodynamic disadvantage with output (thermodilution technique; Edwards model 9528 regard to venous air embolism. Cardiac output and cardiac output computer) were recorded at the fol- stroke volume are decreased from values in the supine lowing times: during steady-state general anesthesia state (19) and many of these patients have a right atrial with constant surgical stimulation immediately before pressure that is higher than left atrial pressure (LAP), applying 10-cm H20 PEEP to the anesthesia circuit; thus possibly placing them at risk for paradoxical air and 5 min after 10-cm H20 PEEP (Boehringer valve) embolism (17). Our results indicate that application was added to the expiratory limb of the anesthesia of 10-cm H20 PEEP in this situation causes a further circuit. reduction in cardiac output and mean arterial pres- Derived hemodynamic variables were calculated sure while simultaneously resulting in a higher right- from appropriate formulae. Values measured during to-left interatrial pressure gradient. If PEEP is used PEEP were compared to those obtained without PEEP prophylactically to prevent air embolism, it appears using Student's t-test for paired data. The incidence that small, otherwise asymptomatic, air bubbles in the of RAP > PCWP was compared before and during venous circulation might be forced through a probe- PEEP using Fisher's exact test. P < 0.05 was regarded patent foramen ovale and into the arterial circulation as significant. where coronary or cerebral damage might occur. If used as treatment of suspected air embolism, PEEP tends to mimic the hemodynamic effects of air em- Results bolism (increased pulmonary vascular resistance, right During surgery in the seated position, institution of ventricular and right atrial pressures, and decreased 10-cm PEEP caused significant reductions in MAP cardiac output) (20), and therefore, might further im- (14%), stroke volume (15%), and CO (15%)without pair cardiovascular performance at a critical juncture. a change in HR or systemic vascular resistance (Table Furthermore, because recent studies indicate delayed 1). There was a 28% increase in pulmonary artery arrival of embolized air bubbles from above the su- pressure (PAP) and a 47% increase in pulmonary vas- perior vena cava (21), rapid institution of PEEP con- cular resistance (PVR). RAP increased significantly ceivably could deliver the critical increase in interatrial with PEEP, whereas PCWP did not increase signifi- pressure gradient required to produce paradoxical air cantly, and the mean interatrial pressure gradient embolus. Although the minimal pressure gradient re- (RAP-PCWP) changed from negative to positive (Fig. quired to cause right-to-left shunting across a probe- 2). Only two patients had RAP > PCWP before PEEP, patent foramen ovale is not known, we have seen whereas seven patients had RAP > PCWP during paradoxical air embolism in a patient with only a + 5 PEEP (P < 0.05). mm Hg RAP-PCWP gradient (17), and it has been PEEP IN THE SEATED POSITION ANESTH ANALG 431 1984;63:429-32 Table 1. PEEP-induced Hemodynamic Changes in Patients in the Seated Position 0-cm HzO PEEP 10-crn H,O PEEP Heart rate (beatsomin I) 78 2 5 78 2 5 Mean arterial pressure (mm Hg) 99.4 ? 9.4 85.6 2 3.P Mean pulmonary artery pressure (mm Hg) 14.8 2 0.7 19.0 2 1.1” Right atrial pressure (mm Hg) 3.6 2 0.9 8.9 2 O.Y Pulmonary capillary wedge pressure (mm Hg) 6.4 2 0.9 7.9 2 0.8 Cardiac output (Lamin I) 5.4 2 0.8 4.6 2 0.5” Stroke volume (ml) 69.2 8.3 59.0 2 11.2’ Systemic vascular resistance (dyne*sec*cm~ 5, 1418 ? 232 1333 2 109 Pulmonary vascular resistance (dyne*sec*cm 5, 124 2 27 192 26“ All values are mean -t scv “D < 0.05 vs 0-cm H20 PEEP shown that a + 4 mm Hg interatrial pressure gradient pressure (3).
Load more

Recommended publications
  • Pressure on Perfusion - Mean Arterial Pressure in Relation to Cerebral Ischemia and Kidney Injury
    Pressure on Perfusion - Mean Arterial Pressure in Relation to Cerebral Ischemia and Kidney Injury Line Larsen and Carina Dyhr Jørgensen Affiliation: Department of Cardiac Thoracic Surgery University Hospital Odense Sdr. Boulevard 29 5000 Odense C, Denmark Supervisor: Claus Andersen, MD, Consultant Anaesthesiologist, Department of Anaesthesiology, V, OUH. Poul Erik Mortensen, MD, Consultant Surgeon, Department of Cardiac Thoracic Surgery, T, OUH. Pressure on Perfusion Line Larsen and Carina Dyhr Jørgensen Index Abstract ........................................................................................................................................................... 2 Introduction ..................................................................................................................................................... 3 Aim ................................................................................................................................................................ 8 Hypothesis ..................................................................................................................................................... 8 Methodological considerations ....................................................................................................................... 9 Materials and methods .................................................................................................................................. 10 Study design ...............................................................................................................................................
    [Show full text]
  • Effects of Vasodilation and Arterial Resistance on Cardiac Output Aliya Siddiqui Department of Biotechnology, Chaitanya P.G
    & Experim l e ca n i t in a l l C Aliya, J Clinic Experiment Cardiol 2011, 2:11 C f a Journal of Clinical & Experimental o r d l DOI: 10.4172/2155-9880.1000170 i a o n l o r g u y o J Cardiology ISSN: 2155-9880 Review Article Open Access Effects of Vasodilation and Arterial Resistance on Cardiac Output Aliya Siddiqui Department of Biotechnology, Chaitanya P.G. College, Kakatiya University, Warangal, India Abstract Heart is one of the most important organs present in human body which pumps blood throughout the body using blood vessels. With each heartbeat, blood is sent throughout the body, carrying oxygen and nutrients to all the cells in body. The cardiac cycle is the sequence of events that occurs when the heart beats. Blood pressure is maximum during systole, when the heart is pushing and minimum during diastole, when the heart is relaxed. Vasodilation caused by relaxation of smooth muscle cells in arteries causes an increase in blood flow. When blood vessels dilate, the blood flow is increased due to a decrease in vascular resistance. Therefore, dilation of arteries and arterioles leads to an immediate decrease in arterial blood pressure and heart rate. Cardiac output is the amount of blood ejected by the left ventricle in one minute. Cardiac output (CO) is the volume of blood being pumped by the heart, by left ventricle in the time interval of one minute. The effects of vasodilation, how the blood quantity increases and decreases along with the blood flow and the arterial blood flow and resistance on cardiac output is discussed in this reviewArticle.
    [Show full text]
  • Chapter 9 Monitoring of the Heart and Vascular System
    Chapter 9 Monitoring of the Heart and Vascular System David L. Reich, MD • Alexander J. Mittnacht, MD • Martin J. London, MD • Joel A. Kaplan, MD Hemodynamic Monitoring Cardiac Output Monitoring Arterial Pressure Monitoring Indicator Dilution Arterial Cannulation Sites Analysis and Interpretation Indications of Hemodynamic Data Insertion Techniques Systemic and Pulmonary Vascular Resistances Central Venous Pressure Monitoring Frank-Starling Relationships Indications Monitoring Coronary Perfusion Complications Electrocardiography Pulmonary Arterial Pressure Monitoring Lead Systems Placement of the Pulmonary Artery Catheter Detection of Myocardial Ischemia Indications Intraoperative Lead Systems Complications Arrhythmia and Pacemaker Detection Pacing Catheters Mixed Venous Oxygen Saturation Catheters Summary References HEMODYNAMIC MONITORING For patients with severe cardiovascular disease and those undergoing surgery associ- ated with rapid hemodynamic changes, adequate hemodynamic monitoring should be available at all times. With the ability to measure and record almost all vital physi- ologic parameters, the development of acute hemodynamic changes may be observed and corrective action may be taken in an attempt to correct adverse hemodynamics and improve outcome. Although outcome changes are difficult to prove, it is a rea- sonable assumption that appropriate hemodynamic monitoring should reduce the incidence of major cardiovascular complications. This is based on the presumption that the data obtained from these monitors are interpreted correctly and that thera- peutic decisions are implemented in a timely fashion. Many devices are available to monitor the cardiovascular system. These devices range from those that are completely noninvasive, such as the blood pressure (BP) cuff and ECG, to those that are extremely invasive, such as the pulmonary artery (PA) catheter. To make the best use of invasive monitors, the potential benefits to be gained from the information must outweigh the potential complications.
    [Show full text]
  • Acute Hemodynamic Effects of Inhaled Sodium Nitrite in Pulmonary Hypertension Associated with Heart Failure with Preserved Ejection Fraction
    Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction Marc A. Simon, … , Ed L. Parsley, Mark T. Gladwin JCI Insight. 2016;1(18):e89620. https://doi.org/10.1172/jci.insight.89620. Clinical Medicine Cardiology Therapeutics BACKGROUND. Pulmonary hypertension (PH) is associated with poor outcomes, yet specific treatments only exist for a small subset of patients. The most common form of PH is that associated with left heart disease (Group 2), for which there is no approved therapy. Nitrite has shown efficacy in preclinical animal models of Group 1 and 2 PH, as well as in patients with left heart failure with preserved ejection fraction (HFpEF). We evaluated the safety and efficacy of a potentially novel inhaled formulation of nitrite in PH-HFpEF patients as compared with Group 1 and 3 PH. METHODS. Cardiopulmonary hemodynamics were recorded after acute administration of inhaled nitrite at 2 doses, 45 and 90 mg. Safety endpoints included change in systemic blood pressure and methemoglobin levels. Responses were also compared with those administered inhaled nitric oxide. RESULTS. Thirty-six patients were enrolled (10 PH-HFpEF, 20 Group 1 pulmonary arterial hypertension patients on background PH-specific therapy, and 6 Group 3 PH). Drug administration was well tolerated. Nitrite inhalation significantly lowered pulmonary, right atrial, and pulmonary capillary wedge pressures, most pronounced in patients with PH-HFpEF. There was a modest decrease in cardiac output and systemic […] Find the latest version: https://jci.me/89620/pdf CLINICAL MEDICINE Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction Marc A.
    [Show full text]
  • What Effects Does Exercise Have on You?
    What Effects Does Exercise Have on You? Suggestions for Teachers Purpose To explore the responses of the heart and blood pressure to exercise Objectives 1) To learn how to take a pulse and blood pressure reading 2) To learn how heart rate responds to exercise 3) To learn how blood pressure responds to exercise Materials · 16" high bench or step · blood pressure cuff (sphygmomanometer) · stethoscope · Graph paper, poster board or overhead transparencies to make heart rate and blood pressure graphs Procedure 1. Practice taking your or a colleague's pulse before the lesson. 2. Practice taking a colleague's blood pressure before the lesson (see diagram). 3. You will find that it is easier for students to take pulse and blood pressure readings if all groups start and stop the step test at the same time ... the room must be quiet while readings are being taken. 4. You may modify the step test to fit your particular situation. For example, we have done the step test on choir risers, bleachers, and building steps. If the step test is not feasible, an alternate exercise could be substituted. However, if you do not use the step test, student numbers are not as accurate for the extension activity in Module #3. Safety · Students should NOT take the pulse at the carotid artery in the neck. · You may want to get parental permission slips for students participating in the step test. This is a relatively strenuous activity in which all students may be unwilling or unable to participate. The more athletic students in your class should have no difficulty with the activity.
    [Show full text]
  • Mean Arterial Pressure in Acute Ischemic Stroke Study
    University of Tennessee Health Science Center UTHSC Digital Commons Theses and Dissertations (ETD) College of Graduate Health Sciences 7-2020 Mean Arterial Pressure in Acute Ischemic Stroke Study Mary Angela Grove University of Tennessee Health Science Center Follow this and additional works at: https://dc.uthsc.edu/dissertations Part of the Medical Sciences Commons, and the Nursing Commons Recommended Citation Grove, Mary Angela (0000-0002-2281-7746), "Mean Arterial Pressure in Acute Ischemic Stroke Study" (2020). Theses and Dissertations (ETD). Paper 527. http://dx.doi.org/10.21007/etd.cghs.2020.0511. This Dissertation is brought to you for free and open access by the College of Graduate Health Sciences at UTHSC Digital Commons. It has been accepted for inclusion in Theses and Dissertations (ETD) by an authorized administrator of UTHSC Digital Commons. For more information, please contact [email protected]. Mean Arterial Pressure in Acute Ischemic Stroke Study Abstract Background. There is little, if any, evidence available on the validation of blood pressure (BP) measurements obtained in the acute care setting. Despite this, acute stroke practitioners trust and rely on non-invasive blood pressure (NIBP) devices to guide acute ischemic stroke (AIS) patients’ treatment. Although systolic blood pressure (SBP) has been found to be the most unreliable measurement displayed on NIBP devices, treatment decisions for AIS are based on them. Today, 25 years after the FDA’s approval of alteplase, practitioners continue to use BP parameters of 185/110 and 180/105 to guide the initiation of alteplase bolus and infusion, although the shift to the use of NIBP devices challenges the validity of these dated parameters.
    [Show full text]
  • Novel Approaches to the Assessment of Systemic Circulation and Ventricular Performance
    University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies The Vault: Electronic Theses and Dissertations 2019-02-27 Novel Approaches to the Assessment of Systemic Circulation and Ventricular Performance Howell, Sarah Howell, S. (2019). Novel Approaches to the Assessment of Systemic Circulation and Ventricular Performance (Unpublished master's thesis). University of Calgary, Calgary, AB. http://hdl.handle.net/1880/109938 master thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY Novel Approaches to the Assessment of Systemic Circulation and Ventricular Performance by Sarah Howell A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE GRADUATE PROGRAM IN CARDIOVASCULAR AND RESPIRATORY SCIENCES CALGARY, ALBERTA FEBRUARY, 2019 © Sarah Howell 2019 Abstract The purpose of evaluating the systemic circulation using systemic vascular conductance and head-capacity curve to quantify left ventricle performance is to validate these assessment approaches instead of more commonly used cardiovascular indexes (i.e., systemic vascular resistance and ejection fraction) used for physiologic responses. Systemic vascular conductance is reciprocal of systemic vascular resistance and is defined as the flow to the systemic circulation that determines arterial pressure. Systemic vascular conductance is calculated by dividing cardiac output by arteriovenous pressure difference.
    [Show full text]
  • BRS Physiology Cases and Problems 2Nd Edition
    48 PHYSIOLOGY CASES AND PROBLEMS Case 10 Essential Cardiovascular Calculations This case is designed to take you through important basic calculations involving the cardio- vascular system. Use the information provided in Table 2-1 to answer the questions. Part of the challenge in answering these questions will be in deciding which information you need in order to perform each calculation. Good luck! TABLE 2-1 Cardiovascular Values for Case 10 Parameter Value Systolic pressure (aorta) 124 mm Hg Diastolic pressure (aorta) 82 mm Hg R-R interval 800 msec Left ventricular end-diastolic volume 140 mL Left ventricular end-systolic volume 70 mL Mean pulmonary artery pressure 15 mm Hg Right atrial pressure 2 mm Hg Left atrial pressure 5 mm Hg 02 consumption (whole body) 250 mL/min 02 content of systemic arterial blood 0.20 mL 02/mL blood 0, content of pulmonary arterial blood 0.152 mL Oz/mL blood R-R interval, time between R waves on the electrocardiogram. QUESTIONS ,„..4 1. Mean arterial pressure is not the simple average of systolic and diastolic pressures. Why not? How is mean arterial pressure estimated? From the information given in Table 2-1, calculate the mean arterial pressure in this case. 2. Calculate the stroke volume, cardiac output, and ejection fraction of the left ventricle. 3. Calculate cardiac output using the Fick principle. 4. What is the definition of total peripheral resistance (TPR)? What equation describes the rela- tionship between TPR, arterial pressure, and cardiac output? What is the value of TPR in this case? 5. How is pulmonary vascular resistance calculated? What is the value of pulmonary vascular resis- tance in this case? Compare the calculated values for pulmonary vascular resistance and TPR, and explain any difference in the two values.
    [Show full text]
  • Elevated Right Sided Pressures in HF Usually Result from Elevated Left Ventricular Filling Pressures
    Sildenafil in Heart Failure with Reactive Pulmonary Hypertension (Sildenafil HF) PI: Maya Guglin, MD, PhD CoInvestigators: Navin Rajagopalan, MD; David Booth, MD; Paul Anaya, MD, PhD Statistician: Richard Charnigo, PhD Pharmacist: Tracy Macaulay, PharmD Sponsor: Gill Heart Institute Scientific Rationale In 2007, Lewis et al1 from Massachusetts General Hospital published a paper on sildenafil, a type 5 phosphodiesterase inhibitor, in heart failure (HF). A single oral dose of 50 mg reduced resting and exercise pulmonary arterial pressure, systemic vascular resistance, and pulmonary vascular resistance, and increased resting and exercise cardiac index (P<0.05 for all) without altering mean arterial pressure, heart rate, or pulmonary capillary wedge pressure. Peak VO2 increased (15+/-9%) and ventilatory response to CO2 output (VE/VCO2 slope) decreased (16+/-5%) just one hour after sildenafil treatment. Improvements were confined to patients with secondary pulmonary hypertension (PH). The study group was 13 patients, which was enough to demonstrate statistical significance of the findings. Pulmonary hypertension (PH) in heart failure (HF) is associated with poor outcomes. In a Mayo Clinic study, there was a strong positive graded association between pulmonary artery systolic pressure (PASP) and mortality. Increasing PASP was associated with an increased risk of death (hazard ratio [HR]: 1.45, 95% confidence interval [CI]: HR: 2.07, 95% CI: 1.62 to 2.64 for the highest PASP tertile versus lowest PASP tertile. This association was independent of age, sex, comorbidities, ejection fraction, and diastolic function 2. Elevated right sided pressures in HF usually result from elevated left ventricular filling pressures. In HF, there are two major components of PH: hydrostatic and vasoreactive3.
    [Show full text]
  • Persistent Depression of Contractility and Vasodilation with Propofol but Not with Sevoflurane Or Desflurane in Rabbits
    Anesthesiology 2008; 108:87–93 Copyright © 2007, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Persistent Depression of Contractility and Vasodilation with Propofol but Not with Sevoflurane or Desflurane in Rabbits Colin Forbes Royse, M.D., B.S.,* David F. L. Liew,† Christine E. Wright, Ph.D.,‡ Alistair G. Royse, M.D., B.S.,‡ James A. Angus, Ph.D.§ Background: Propofol, sevoflurane, and desflurane may rent use in the intensive care environment. These drugs cause hemodynamic compromise during anesthesia and critical are popular general anesthetics for a number of reasons care management. The aim of the study was to compare these including relatively rapid onset and offset of anesthe- anesthetics during increased dose and recovery to maintenance 1–3 Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/108/1/87/366308/0000542-200801000-00015.pdf by guest on 29 September 2021 level. sia, and they are considered to have relatively few side Methods: Anesthetized, open-chest New Zealand White rab- effects. However hypotension and vasodilation are com- bits were used to acquire dose–response curves with sevoflu- mon associated cardiovascular sequelae.4–6 rane, desflurane, and propofol, followed by reduction to base- Because most anesthetic agents have both myocardial line infusion. Simultaneous high-fidelity left ventricular depressant and vasodilator properties, it is difficult to pressure and volume data were acquired during caval occlusion with a dual-field conductance catheter inserted via an apical separate myocardial from vascular effects using ejection stab. The preload recruitable stroke work and the end-diastolic phase indices of systolic function (such as cardiac output pressure–volume relationship were used as the primary mea- or ejection fraction).
    [Show full text]
  • Arterial Blood Pressure
    ARTERIAL BLOOD PRESSURE Prof. Sultan Ayoub Meo MBBS, Ph.D (Pak), M Med Ed (Dundee), FRCP (London), FRCP (Dublin), FRCP (Glasgow), FRCP (Edinburgh) Professor and Consultant, Department of Physiology, College of Medicine, King Saud University, Riyadh, KSA LECTURE OBJECTIVES ▪ Define Arterial blood pressure ▪ Systolic and Diastolic blood pressure ▪ Normal values of Systolic and Diastolic blood pressure ▪ Hypotension and Hypertension ▪ Physiological significance ▪ Describe physiological variation in arterial blood pressure. ▪ Explain the effect of gravity on arterial blood pressure. ▪ Pulse pressure, Mean Arterial pressure ▪ Describe how BP is measured ▪ Clinical features and complications of Hypertension ARTERIAL BLOOD PRESSURE The pressure / force exerted by the blood against any unit area of the vessel wall is called Blood Pressure. Standard Units of Blood Pressure Blood pressure is mainly measured in: Millimeters of mercury (mm Hg) Occasionally, BP is measured in: Centimeters of water (cm H2O) One millimeter of mercury pressure equals 1.36 centimeters of water pressure because the specific gravity of mercury is 13.6 times that of water, and 1 centimeter is 10 times as great as 1 millimeter. Guyton and Hall, pp 174 ARTERIAL BLOOD PRESSURE Systolic Blood Pressure: The force exerted by the blood against any unit area of the vessel wall while heart is contracting (Systole) is called Systolic Blood Pressure. 120 mmHg Diastolic Blood Pressure: The force exerted by the blood against the unit area of the vessel wall while heart is relaxing (Diastole) 80 mmHg Average Normal Arterial Pressure: 80-120 mmHg systolic 60-80 mmHg diastolic Guyton and Hall, pp 174 ARTERIAL BLOOD PRESSURE ARTERIAL BLOOD PRESSURE ARTERIAL BLOOD PRESSURE IN DIFFERENT PARTS OF THE CIRCULATORY SYSTEM Highest at the heart.
    [Show full text]
  • The Effects of Handgrip Stress Test on Hemodynamic Parameters Before
    38 The Effects of Handgrip Stress Test on Hemodynamic Parameters Before and After Cilazapril Treatment in Patients with Heart Failure Talat Tavl›, MD, Hakan Göçer, MD Department of Cardiology, Celal Bayar University, School of Medicine, Manisa, Turkey Objective: To assess the effect of cilazapril treatment on several hemodynamic parameters during handg- rip maneuvers in patients with congestive heart failure. Cilazapril, an ACE inhibitor with high affinity, has been shown to be highly effective against a variety of vascular disorders. The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamic parameters before and after cilazapril tre- atment in patients with congestive heart failure is unknown. Methods: The study population included 30 patients (16 male, 14 female) with mean age of 65±18 ye- ars. The effects of handgrip maneuver on hemodynamic parameters were studied by right heart cathete- rization and Doppler echocardiography. Results: Heart rate (HR) and mean arterial pressures (MAP) increased significantly after handgrip mane- uver (from 95±6 beats/min to 101±12 beats/min; from 109±15 mm Hg to 118±19 mm Hg, p<0.05 res- pectively). Pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic (s) and diastolic (d) pres- sures (PAP), cardiac index (CI), right ventricular systolic and diastolic pressures (RVPs and RVPd), left vent- ricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) did not change after handgrip ma- neuvers (p>0.05). On the other hand, PAPs and PAPd , RVPs and RVPd, MAP and HR (p<0.05) decreased significantly during handgrip maneuvers after cilazapril treatment. However PCWP and CI, LVEF, RVEF did not change after treatment (p>0.05).
    [Show full text]